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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT I SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 14UN-NtrUNUABLt t'tHMIT GALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS FOUNDATION VQ CITY/ZIP lA 1- -14k 7 S -3 777 CROSS STREET t/�� ul<: �"Q�. APN � t✓ V / PARCEL SIZE OD OWNER NAME L49t/1 P jA ,#->4-qr, Lj .� PHONE :33 1 - 9 a-- 7 OWNER ADDRESS ��Y!`K.� CITY/STATE/ZIP ��'- ✓1''t�/1~ i :+V r' 15 �T CONTRACTOR 0M I' IS e)94-K�'j"ty t/ _ PHONE ft PROPERTY LINE CONTRACTOR ADDRESS ; a r'a� S l� CITY/STATE21P v'1 �f'VI. t% c�' �� TS LICENSE I C-42 I I C-36 OTHER NUMBER ,i�� EXPIRATION DATE DISTANCE TO NEAREST WATER TABLE DEPTH: (J ` ft GEOGRAPHICAL INFORMATION PERC TEST # BUILDING PERMIT #-,..,, TYPE OF WORK: NEW INSTALLATION REPAIR/ADI Coordinates X LAND USE APPLICATION #_ / IN ENGINEER DE' w REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION M!9q!Mq J,&iC INSTALLATION WILL SERVE: RESIDENCE _l COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS:n ( NUMBER OF BEDROOMS: =� NUMBER OF EMPLOYEES: A SEPTIC TANK TYPE/MFG L CAPACITY -�Lmao gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY _ gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL jL) I ? ft FOUNDATION (;/�' ft PROPERTY LINE 15 ? ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 11 ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE FILTER BED WIDTH 016, ft LENGTH Ll � ft DEPTH IT 1 b I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSAIION LAWS. SIGNED Application Accepted Final Inspection By.' Character of Soil to D COMMENTS �fk I //YROWIili/� RED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 TITLE C n^ J�N'I- DATE 72 • i, f JSE10 NJ, Y 1 Area Employee ID# r ❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: is DeGiio/-) MCA ha i1 PE Code DISTANCE TO NEAREST WELL I on, ft FOUNDATION B'it ft PROPERTY LINE MOUNDED WIDTH ft LENGTH o ft DEPTH Z o DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE SUMPS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE SEEPAGE PITS NUMBER WIDTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE b I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSAIION LAWS. SIGNED Application Accepted Final Inspection By.' Character of Soil to D COMMENTS �fk I //YROWIili/� RED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 TITLE C n^ J�N'I- DATE 72 • i, f JSE10 NJ, Y 1 Area Employee ID# r ❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: is DeGiio/-) MCA ha i1 PE Code SC INFO Received B Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# o 1 adz Z o 5"7--1 r 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17